Healthcare Provider Details

I. General information

NPI: 1417939935
Provider Name (Legal Business Name): LORI SUSAN MOLENAAR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.K. UNIVERSITY HEALTH SERVICE 740 S. LIMESTONE ST KY CLINIC SUITE 163-B
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

1013 STOWBRIDGE LN
LEXINGTON KY
40515-5073
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5511
  • Fax: 859-323-1119
Mailing address:
  • Phone: 859-271-0245
  • Fax: 859-323-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberKY 2423S
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number3002423
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: